Major depression can be regarded as a systemic neurobehavioral disorder resulting from dysfunction of the limbic-cortical networks. The cingulum bundle represents a major association fiber tract of those networks. The aim of our study was to determine the association of brain structural tissue markers of the cingulum bundle and cognitive function in patients with major depression.

Region-of-interest-based analyses of the middle-anterior and middle-posterior cingulum bundle fractional anisotropy (FA) and mean diffusivity (MD) using color-coded diffusion-tensor imaging and neuropsychological assessment in 14 patients with major depression.

FA of the middle-anterior and middle-posterior cingulum bundle was significantly correlated to the performance in a planning and divided attention task. Furthermore, MD of the middle-posterior cingulum bundle was significantly correlated to a planning task. There was no significant correlation between FA and MD of the cingulum bundle and selective attention or memory.

Brain structural tissue markers of the middle-anterior and middle-posterior cingulum bundle were found to be associated with executive functioning and divided attention in patients with major depression. Disconnection within the limbic-cortical networks may underlay cognitive dysfunction in major depression.

It is not known how characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts.

Data on 1921 suicide attempts was gathered in a major German city over a 5-year period. Suicide attempts were categorised according to a diagnosis of alcohol use disorder and acute alcohol consumption at the time of the attempt. Group comparisons and multinomial logistic regression were used for statistical analysis.

In 331 suicide attempts (17%) an alcohol use disorder was diagnosed. Six hundred and twenty-two suicide attempts (32%) were committed with acute alcohol consumption. Suicide attempts by individuals with alcohol use disorder were more often committed by men, older individuals and as a recurrent attempt, independently of alcohol consumption at the time of the attempt. When alcohol was consumed in suicide attempts by individuals with alcohol use disorder, low-risk methods were used most often.

Individuals with a diagnosis of alcohol use disorder are a high-risk group for multiple suicide attempts and should be a target group for suicide prevention. Screening for suicidality should be a regular part of the clinical assessment in individuals with alcohol use disorder.

Theory of mind (ToM) is the ability to represent one's own or another's mental states and has been found to be impaired in many psychiatric disorders. Our objective was to compare ToM abilities of patients with obsessive-compulsive disorder (OCD) with healthy controls and to investigate the relation between some illness features, other cognitive functions and ToM abilities of patients.

Thirty OCD patients and age, sex and education matched 30 healthy controls were compared according to their performances on ToM tasks (including first and second order false belief, hinting task and double-bluff task), verbal memory processes test, Weschler memory test (WMT) (logical memory, visual reproduction and digit span sub-tests), stroop test.

Patients’ performances were worse than healthy controls on all of the ToM tasks, but the results were significant for only for double-bluff task (t = −3.992, df = 36.157, p < 0.01). Performance on double-bluff task was significantly and positively correlated with visual reproduction-immediate recall (r = −0.411, p < 0.05) and visual reproduction-delayed recall (r = 0.478, p < 0.05), hinting task was significantly and positively correlated with verbal memory (r = 0.481, p < 0.05).

These results show “basic” ToM abilities of OCD patients are generally preserved, but they show significant reduction in their “advanced” ToM abilities, which seem to be related to their reduced memory capacities. The possible reasons for the relation between memory and ToM impairments, as well as the clinical significance of ToM deficits in OCD are discussed.

Immigration is a factor with effects on the course of substance abuse and treatment response, however there is little consistent data regarding outcome of inpatient opiate detoxification treatment in immigrants as compared to native patients.

Patient history and the success of current detoxification treatment were systematically documented in a multicenter study in Germany which included 10 psychiatric hospitals with specialized detoxification wards.

Out of 893 patients, 240 (27%) had a migration history. We further analyzed the three main groups (German, n = 653; Turkish, n = 58; Russian origin, n = 103). There were significant differences between groups regarding sociodemographic data, drug history, treatment experience and success of current treatment. However, considering the younger age of patients with Russian origin, analysis of younger patients (< 31 years) detected only minor group differences. In multiple logistic regressions age and center showed statistically significant associations with all outcome variables (early dropout, achievement of drug-free urine screen, regular completion of detoxification treatment, and referral to further treatment), while (Russian) origin was associated only with premature termination of treatment.

Young men were the main problem group regardless of origin. Significant center effects raise doubts regarding results from monocenter research.

Residual depressive symptoms are generally documented as a risk factor for recurrence. In the absence of a specific instrument for the assessment of residual symptoms, a new 25-item Depression Residual Symptom Scale (DRSS) was elaborated and tested for recurrence prediction over a 1-year follow-up.

Fifty-nine patients in remission after a major depressive episode (MDE) were recruited in two centres. They were assessed with the DRSS and the Montgomery-Asberg Depression Rating Scale (MADRS) at inclusion and followed for 1 year according to a seminaturalistic design. The DRSS included specific depressive symptoms and subjective symptoms of vulnerability, lack of return to usual self and premorbid level of functioning.

Severity of residual symptoms was not significantly associated with increased risk of recurrence. However, DRSS score was significantly higher among patients with three or more episodes than one to two episodes. Number of previous episodes and treatment interruption were not identified as significant predictors of recurrence.

The proposed instrument is not predictive of depressive recurrence, but is sensitive to increased perception of vulnerability associated with consecutive episodes. Limitations include small sample size, seminaturalistic design (no standardisation of treatment) and content of the instrument.

Migrating implies a high level of stress that may destabilise immigrants’ mental health. The sense of spiritual fulfilment (feelings of faith, religiosity, and transcendence beyond ordinary material life) can mitigate the stress and benefit mental health. The objective of the present study was to analyze the relationship between migratory stress, religiosity and depression symptoms, as well as the mediating role of religiosity between migratory stress and depression symptoms.

Participants were 295 Latin American immigrants living in Barcelona (Spain), 186 of whom (63.1%) were women and 109 (36.9%) were men. They were recruited from a Spanish NGO by means of a consecutive-case method.

The results showed an inverse relationship between religiosity and depression symptoms, but only in women. Likewise, in women, the sense of spiritual fulfilment had mediating value in buffering the relationship between stress and depression symptoms. This mediating value of spiritual fulfilment was not observed in men. For both genders religiosity was inversely related with stress. In addition, it was observed that the sense of religiosity decreases as the time since immigration passes.

These results may be of importance in clinical practice for prevention and therapeutic intervention with Latin American immigrants. As sense of transcendence and social support from the religious community are intertwined, it is difficult to specifically attribute the observed benefit of religiosity to the former versus the later.

To perform a psychometric analysis of the Brazilian version of the Brief Social Phobia Scale (BSPS).

Hundred and seventy-eight university students of both genders aged on average 21.2 years and identified as Social Anxiety Disorder (SAD) cases and non-cases was studied, with the structured clinical interview for DSM-IV being used as a parameter. The different instruments were applied in an individual manner in the presence of a rater and of an observer.

The BSPS showed adequate internal consistency (0.48–0.88) and concurrent and divergent validity with the Beck Anxiety Inventory (BAI) (0.21–0.62), Social Phobia Inventory (0.24–0.82) and Self Statements During Public Speaking Scale (SSPS) (0.23–0.31). Discriminative validity revealed a sensitivity of 0.88–0.90 and a specificity of 0.81(0.83 for cut-off notes of 18/19. Factorial analysis demonstrated the presence of six factors that jointly explained 71.79% of data variance. Construct validity indicated some limits of the scale regarding the diagnosis of SAD. Inter-rater reliability was strong (0.86–1.00, p < 0.001).

The BSPS is adequate for use with university students, although further studies in different cultures, samples and contexts are still necessary.

To determine whether the modified version of the Suicide Assessment Scale (SUAS) can be utilised to predict risk of repeat suicidal behaviour.

Hundred and sixty-five patients aged 18 to 68 years who were admitted to emergency wards after a suicide attempt were interviewed. Follow-up interviews (n = 96) were carried out after 2 months. Associations between SUAS scores and repeat attempt (fatal/non-fatal) during the following 3 years were analysed and the instrument's ability to predict repetition was assessed.

High SUAS score (>30) was associated with repetition. The ability of the SUAS to correctly predict repeat suicidal behaviour in the entire study group was low (AUC = 0.65, 95% CI = 0.56–0.74) but better for those (n = 42) who reported ongoing psychiatric treatment at follow-up (AUC = 0.78, 95% CI 0.63–0.94). Among the latter group, all with baseline SUAS scores >30 made repeats.

The modified SUAS performed well as a screening instrument in psychiatric patients.

In this study, we evaluated brain perfusion in patients with first-episode medicated schizophrenia using the new analytical method, statistical parametric mapping (SPM) applied to single photon emission computed tomography (SPECT).

We performed SPECT with 99-Tc-ethyl cysteinate dimer (99mTc-ECD) of the brain and magnetic resonance imaging (MRI) in patients with schizophrenia (n = 30) and control subjects matched for age and gender (n = 37). A voxel-by-voxel group analysis was performed using SPM2 (Z > 3.0, P < 0.001, uncorrected for multiple comparisons).

In comparison with control subjects, the volumes of the bilateral frontal areas were found to be decreased on MRI. Blood flow was found to be reduced in the bilateral temporal areas in the patients with schizophrenia on SPECT.

In this study, patients with first-episode schizophrenia appeared to have significant bilateral temporal hypoperfusion, although temporal volumes were not significantly decreased in comparison with control subjects. Abnormality of temporal lobe blood flow in schizophrenia may show that functional changes occur earlier than structural changes, and may assist in the diagnosis of schizophrenia.

The study focuses on the point prevalence of major depressive episode in the Estonian population in 2006 and assesses the relationship of sociodemographic factors, health status indicators, alcohol use, and previous depressive episodes to major depression.

The present major depressive episode was assessed within the nationally representative, cross-sectional 2006 Estonian Health Survey (EHIS 2006), in which non-institutionalized individuals aged 18–84 years (n = 6105) were interviewed using the Mini-International Neuropsychiatric Interview (MINI).

The point prevalence of major depressive episode in the Estonian population was 5.6%. Depression was higher among females, in the non-Estonian ethnic group, among people older than 40 years, and in the lower-income group.

The point prevalence of major depressive episodes was comparable with the results of other population surveys, being a little higher than the average. Age, income, ethnicity, health status, self-rated health, and previous depressive episode were independent associates of depression.

To evaluate social and occupational functioning in patients in partial remission (PR) compared with patients in complete remission (CR) of a major depressive disorder (MDD) episode.

This is a six-month prospective study. PR was defined as a score more than 7 and less or equal to 15 in the Hamilton Depression Rating Scale, and CR as less or equal to 7. All patients had been on acute antidepressant treatment during the previous three months and no longer met criteria for MDD. Functioning was assessed by the Social and Occupational Functioning Assessment Scale (SOFAS).

Mean (S.D.) patient age was 50.5 (14.5) years (N = 292) and 77% were female. At baseline, partial remitters showed greater impairment in social and occupational functioning than complete remitters (62.8 [12.6] versus 80.4 [10.5], respectively; P < .0001). After six months, only 47% PR versus 77% CR reached normal functioning, and SOFAS ratings for PR were below normal range (76.2 [12.3] PR versus 84.6 [9.4] CR; P < .0001). PR reported three times more days absent from work due to sickness than CR (63 days versus 20 days; P < .001).

We conclude that PR of an MDD episode is associated with significant functional impairment that persists even after nine months of antidepressant treatment. Our results underline the importance of treating the patient until achieving full remission.

One type of the treatment interventions is the “off label” use of a drug, which may include the use of a drug in a nonapproved indication, dose range, age group, drug combination and drug formulation. Research in this field is insufficient, while the medical, financial and legal consequences of off label use maybe serious. In case of off label use of a drug the manufacturer does not have any responsibility in case of adverse or serious adverse events.

Labels (summary of product characteristics) of antipsychotic drugs have been compared for indications and examples of regulations for off label use have been collected.

Labels (summary of product characteristics) very rarely include indications for children, adolescents and for the elderly. A significant proportion of psychotic disorders listed in DSM-IV or in ICD 10 and major clinical syndromes have not been included as indications in the label of antipsychotic drugs. The same compound marketed by different companies under different names may have different labels.

The regulations for off label use of drugs vary between countries and as of today there is no common European regulation for off label drug use. In some countries off label drug prescription is not restricted, these prescriptions maybe reimbursed. Some countries restrict reimbursement of off label prescriptions and there are countries restricting the prescriptions.

More research (especially in young and old age groups) is needed in this field and some European guidelines/regulation would increase the safety of using drugs off label.

Abnormalities of orbitofrontal cortex (OFC) sulcogyral patterns have been reported in schizophrenia, but it is not known if these predate psychosis.

Hundred and forty-six subjects at high genetic risk of schizophrenia, 34 first episode of schizophrenia patients (SZ) and 36 healthy controls were scanned and clinically assessed. Utilising the classification system proposed by Chiavaras, we categorised OFC patterns and compared their distribution between the groups, as well as between those high risk subjects who did, and did not develop schizophrenia. The relationship between OFC pattern and schizotypy was explored in high risk subjects.

We refined Chiavaras’ classification system, with the identification of a previously unreported variant of OFC surface structure. There were significant differences in distribution of OFC patterns between high risk subjects who did or did not develop schizophrenia as well as between the first episode of schizophrenia group and healthy controls. Within the high risk group, possession of OFC Type III was associated with higher ratings on the Structured Inventory for Schizotypy (SIS) psychotic factor.

Our results suggest that OFC Type III is associated with psychotic features before the development of schizophrenia. Characterisation of OFC morphology may have a role in the identification of those at greatest risk of developing schizophrenia.